Vomiting with Abdominal Pain Unrelated to Food and Without Fever (Non-metabolic Causes)

CLINICAL DIAGNOSTIC MANUAL

Vomiting accompanied by abdominal pain, not related to food intake and without fever, may indicate various serious pathologies, most of which require rapid medical intervention. These conditions, which are not of metabolic origin, can include obstructions in the large intestine, ischaemic events in the mesenteric vasculature, and conditions in distant organs that present with reflex abdominal pain, such as an inferior acute myocardial infarction. Given the severity of the situation, it is crucial to differentiate between the various causes through a comprehensive diagnostic approach, using both imaging tests and haemodynamic and laboratory studies.

Pathology	Symptoms and Clinical Signs	Suspicion Diagnosis	Confirmation Diagnosis
Large intestine obstruction	Progressive abdominal pain, distension, vomiting, absence of bowel movement or gas. History of chronic constipation.	Acute abdominal pain with distension and absence of peristalsis.	Radiography or abdominal CT showing distension of intestinal loops or point of obstruction.
Hepatic carcinoma	Vague abdominal pain, nausea, vomiting, weight loss, jaundice, possible palpable mass in the right hypochondrium.	Palpable mass in right hypochondrium with weight loss and history of cirrhosis or chronic hepatitis.	Abdominal ultrasound or CT showing liver masses. Hepatic biopsy confirmatory.
Mesenteric artery occlusion	Sudden, severe abdominal pain disproportionate to the physical examination. Vomiting, diarrhoea or bloody stools.	Acute and severe abdominal pain, history of cardiovascular disease or emboli.	Mesenteric angiography showing arterial occlusion.
Kidney stones	Sharp flank pain radiating to the groin, nausea, vomiting, occasional haematuria.	Acute lower back pain radiating to the groin, accompanied by haematuria.	Abdominal ultrasound or CT showing stone in the urinary tract.
Ectopic pregnancy or miscarriage	Pelvic or lower abdominal pain, vaginal bleeding, nausea, vomiting, hypotension in cases of ruptured ectopic pregnancy.	Lower abdominal or pelvic pain in women of childbearing age with vaginal bleeding.	Transvaginal ultrasound showing gestational sac outside the uterus (ectopic) or signs of miscarriage.
Inferior acute myocardial infarction	Abdominal or epigastric pain, nausea, vomiting, sweating, pallor, vagal symptoms.	Epigastric pain associated with cardiovascular risk factors, history of angina or infarction.	ECG showing changes in inferior leads (II, III, aVF). Elevated cardiac markers (troponins).
Congestive heart failure with hepatic congestion	Vague abdominal pain, abdominal distension, nausea, vomiting, peripheral oedema, ascites.	History of heart failure with symptoms of hepatic congestion and abdominal distension.	Echocardiogram showing ventricular dysfunction. Altered liver tests (elevated bilirubins, transaminases).